Acute Necrotizing Encephalitis in Viral Respiratory Tract Infection: An Autopsy Case Report

Stoyanov, George S; Lyutfi, Emran; Dzhenkov, Deyan; Petkova, Lilyana

doi:10.7759/cureus.8070

Cited by 9 publications

(12 citation statements)

References 8 publications

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“…Based on the clinical studies and the limited neuropathological data, CNS histopathology encompasses hypoxic/ischemic encephalopathy, activated microglial cells with variable infiltration of perivascular T lymphocyte, cerebrovascular diseases, AHNE, encephalitis/meningitis, acute myelitis, demyelinating disorders, and PNS involvement [ 21 , 68 , 71 , 73 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 ], with histologically documented lesions in some studies [ 6 , 11 , 68 , 69 , 71 , 72 , 73 ].…”

Section: Resultsmentioning

confidence: 99%

“…Severe COVID-19 cases, therefore, are at high risk of thrombosis secondary to an indirect hypercoagulable state and a direct vascular endothelial damage [ 116 ]. In AHNE, coagulative neuronal necrosis, reactive gliosis, and perivascular lymphocytic infiltration with cell debris or inclusions were the main histological aspects [ 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…After this process, 46 studies performed autopsy: 39 showing pulmonary, cardiovascular, or other organ involvement ( Appendix A ), and 7 showing brain pathology ( Table 1 ). Among them, only 3 autopsy studies demonstrated a RT-qPCR-positive viral infection [ 68 , 69 , 70 ].…”

Section: Data Sources and Selectionmentioning

confidence: 99%

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Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

Fisicaro

Napoli²,

Liberto

et al. 2021

IJERPH

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Background: Neuroinvasive properties of SARS-CoV-2 have allowed the hypothesis of several pathogenic mechanisms related to acute and chronic neurological sequelae. However, neuropathological correlates have been poorly systematically investigated, being retrieved from reports of single case or limited case series still. Methods: A PubMed search was carried out to review all publications on autopsy in subjects with “COronaVIrus Disease-19” (COVID-19). Among them, we focused on histological findings of the brain, which were compared with those from the authors’ autoptic studies performed in some COVID-19 patients. Results: Only seven studies reported histological evidence of brain pathology in patients deceased for COVID-19, including three with reverse transcription–quantitative polymerase chain reaction evidence of viral infection. All these studies, in line with our experience, showed vascular-related and infection-related secondary inflammatory tissue damage due to an abnormal immune response. It is still unclear, however, whether these findings are the effect of a direct viral pathology or rather reflect a non-specific consequence of cardiovascular and pulmonary disease on the brain. Conclusions: Notwithstanding the limited evidence available and the heterogeneity of the studies, we provide a preliminary description of the relationship between SARS-CoV-2 and brain sequelae. Systematic autoptic investigations are needed for accurate detection and adequate management of these patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

Fisicaro

Napoli²,

Liberto

et al. 2021

IJERPH

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“…Postmortem examination is known as the most definitive mean to assess viral neuroinvasion in patients with COVID‐19 14 . Since Paniz‐Mondolfi et al 46 reported the first autopsy evidence of SARS‐CoV‐2 viral particles in the brain parenchyma of a COVID‐19 patient by electron microscopy and PCR assays on April 21, 2020, increasing autopsy studies on patients with COVID‐19 have been published 39,46‐72 …”

Section: Discussionmentioning

confidence: 99%

What can cerebrospinal fluid testing and brain autopsies tell us about viral neuroinvasion of SARS‐CoV‐2

Zhang

Tan

2021

Journal of Medical Virology

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To provide instructive clues for clinical practice and further research of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we analyzed the existing literature on viral neuroinvasion of SARS-CoV-2 in coronavirus disease 2019 (COVID-19) patients. To date, SARS-CoV-2 has been detected in the cerebrospinal fluid (CSF) or brain parenchyma in quite a few patients, which provide undeniable evidence for the neuroinvasive potential of this novel coronavirus. In contrast with the cerebrum and cerebellum, the detection rate of SARS-CoV-2 was higher in the olfactory system and the brainstem, both of which also showed severe microgliosis and lymphocytic infiltrations. As compared with the number of patients who underwent viral testing in the central nervous system (CNS), the number of patients showing positive results seems very small. However, it seems too early to conclude that the neuroinvasion of SARS-CoV-2 is rare in COVID-19 patients because the detection methods or sampling procedures in some studies may not be suitable or sufficient to reveal the CNS infection induced by neurotropic viruses. Moreover, the primary symptoms and/or causes of death were distinctly different among examined patients, which probably caused more conspicuous pathological changes than those due to the direct infection that usually localized to specific brain areas.Unfortunately, most autopsy studies did not provide sufficient details about neurological symptoms or suspected diagnoses of the examined patients, and the documentation of neuropathological changes was often incomplete. Given the complex pathophysiology of COVID-19 and the characteristics of neurotropic viruses, it is understandable that any study of the CNS infection may inevitably have limitations.

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“…The cerebral MRI of the first patient with SARS-CoV-2-associated AHNE displayed a hemorrhagic rim enhancing lesions within the thalami, medial temporal lobes, and subinsular regions [ 19 ]. AHNE was also reported in a 59-year-old woman with anemia, seizures, and somnolence [ 21 ] and, on autopsy, in a polymorbid 77-year-old woman [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2-Associated Acute Hemorrhagic, Necrotizing Encephalitis (AHNE) Presenting with Cognitive Impairment in a 44-Year-Old Woman without Comorbidities: A Case Report

et al. 2020

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Patient: Female, 44-year-old Final Diagnosis: COVID-19 Symptoms: Confusion Medication:— Clinical Procedure: — Specialty: Neurology Objective: Rare disease Background: Acute hemorrhagic necrotizing encephalitis (AHNE) is a rare manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. AHNE usually involves the subcortical white matter but not the cortical grey matter. This study describes the disruptive effects of AHNE associated with SARS-CoV-2 on cognitive function in a previously healthy and sound middle-aged woman resulting from alterations in cortical areas involved in the cognitive network. Case Report: A 44-year-old previously healthy woman with a history of inter-state travel developed a flu-like illness, followed by acute, steadily progressive cognitive impairment. She was admitted in a comatose state after a first tonic-clonic seizure. Blood tests were non-informative. Cerebral magnetic resonance imaging (MRI) was indicative of AHNE. Cerebrospinal fluid analysis showed mild lymphocytosis with normal protein and normal glucose but an elevated IgG index. After testing positive for SARS-CoV-2, she was administered steroids. Treatment was ineffective, and the patient died. Conclusions: SARS-CoV-2 is a potential central nervous system (CNS) pathogen, which may manifest as AHNE. These patients may present with generalized tonic-clonic seizures and frontal dysexecutive syndrome, with cognitive impairment being the presenting feature of neuro-coronavirus disease-2019 (COVID-19). The patient described in this report is unique for acute-onset and isolated cognitive impairments due to SARS-CoV-2 infection in the absence of clinical or radiological respiratory manifestations. These findings may help in the early detection and diagnosis of neuro-COVID-19, especially among clinicians and neurologists working in areas of endemic SARS-CoV-2 infection.

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Acute Necrotizing Encephalitis in Viral Respiratory Tract Infection: An Autopsy Case Report

Cited by 9 publications

References 8 publications

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

What can cerebrospinal fluid testing and brain autopsies tell us about viral neuroinvasion of SARS‐CoV‐2

SARS-CoV-2-Associated Acute Hemorrhagic, Necrotizing Encephalitis (AHNE) Presenting with Cognitive Impairment in a 44-Year-Old Woman without Comorbidities: A Case Report

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